STUDENT ENROLMENT APPLICATION

PERSONAL DETAILS
Title: Given Names: Surname:

Male Female Other Date of Birth: City/Town of Birth:

UNIQUE STUDENT IDENTIFIER (USI) Students can register at www.usi.gov.au.

Do you have A USI? Yes Please clearly write your USI:..........................................................................................................................

No Please complete the attached consent form for Coal Train to create the USI on your behalf.

CONTACT DETAILS

Phone: Mobile:

Email Address:

Alternative Email Address:

Address: Postal Address: (Same )

City: Suburb:

State: Post Code:

Emergency Contact Name: Relationship:

Contact Number (Home): Contact Number (Mobile):

BILLING DETAILS

Company (Details below) Private (As per above details)

Company Name: Address:

Phone: Purchase Order Number:

Email Address:

LANGUAGE & CULTURAL DIVERSITY

Country of Birth: Other

Australia Other (please
(please specify):
specify): Country of Citizenship:
Country of Citizenship:

Do you speak any other language at home? No Yes (please specify):

How well do you speak English: Very well Well Not well Not at all

Aboriginal or Torres Strait Islander: No Yes, Aboriginal Yes, Torres Strait Islander

DISABILITY

Do you consider yourself to have a disability, impairment or long-term condition? Yes No

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:
(You may indicate more than one area) Please refer to the Disability supplement for an explanation of the following disabilities.
Hearing/deaf Physical Intellectual Learning
Mental illness Acquired brain impairment Vision
Medical condition Other (please specify):

Student Enrolment Application | 2022

 STUDENT ENROLMENT APPLICATION
EDUCATION
Highest Completed School Level: Year Completed:

Currently at Secondary School: Yes No LUI Number:

If yes, name of School:

PREVIOUS QUALIFICATIONS ACHIEVED

Have you SUCCESSFULLY completed any of the qualifications listed? Yes No

If YES, tick ANY applicable boxes.
Bachelor degree or higher degree Advanced diploma or associate degree Diploma (or associate diploma)
Certificate IV (or advanced certificate/technician) Certificate III (or trade certificate) Certificate II
Certificate I Other education (including certificates or overseas qualifications not listed above)

EMPLOYMENT
Of the following categories, which BEST describes your current employment status?

Full Time Employed unpaid worker in a family business

Part Time Unemployed seeking full time work

Self Employed Unemployed seeking part time work

Employer Unemployed Not Seeking Work

STUDY REASON
Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/
apprenticeship (Tick ONE box only):
To get a job To develop my existing business To start my own business To try for a different career
To get a better job or promotion It was a requirement of my job I wanted extra skills for my job
To get into another course of study For personal interest or self-development Other reasons
To get skills for community/voluntary work

ALLERGY INFORMATION
Unfortunately, students with severe food allergies cannot be catered for and are
Allergies: requested to bring their own meals. There is a fridge available for food storage.

HOW DID YOU HEAR ABOUT US

TV/Radio Ad Print Ad Search engine Social network Event
Other..........................................................................................................................................................................................................................................

CURRENT COURSE ENROLMENT

Course Title:

PLEASE COMPLETE ALL SECTIONS OF THE FORM INCLUDING THE FOLLOWING PAGE
WHY WE COLLECT YOUR PERSONAL INFORMATION
As a registered training organisation (RTO), we collect your personal information so we can process and manage your enrolment in a vocational
education and training (VET) course with us.

HOW WE USE YOUR PERSONAL INFORMATION

We use your personal information to enable us to deliver VET courses to you, and otherwise, as needed, to comply with our obligations as an RTO.

HOW WE DISCLOSE YOUR PERSONAL INFORMATION

We are required by law (under the National Vocational Education and Training Regulator Act 2011 (Cth) (NVETR Act)) to disclose the personal
information we collect about you to the National VET Data Collection kept by the National Centre for Vocational Education Research Ltd (NCVER).
The NCVER is responsible for collecting, managing, analysing and communicating research and statistics about the Australian VET sector.
We are also authorised by law (under the NVETR Act) to disclose your personal information to the relevant state or territory training authority.

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 STUDENT ENROLMENT APPLICATION
HOW THE NCVER AND OTHER BODIES HANDLE YOUR PERSONAL INFORMATION
The NCVER will collect, hold, use and disclose your personal information in accordance with the law, including the Privacy Act 1988 (Cth) (Privacy
Act) and the NVETR Act. Your personal information may be used and disclosed by NCVER for purposes that include populating authenticated VET
transcripts; administration of VET; facilitation of statistics and research relating to education, including surveys and data linkage; and understanding
the VET market.
The NCVER is authorised to disclose information to the Australian Government Department of Education, Skills and Employment (DESE),
Commonwealth authorities, State and Territory authorities (other than registered training organisations) that deal with matters relating to VET and
VET regulators for the purposes of those bodies, including to enable:
• administration of VET, including program administration, regulation, monitoring and evaluation
• facilitation of statistics and research relating to education, including surveys and data linkage
• understanding how the VET market operates, for policy, workforce planning and consumer information.
The NCVER may also disclose personal information to persons engaged by NCVER to conduct research on NCVER’s behalf. The NCVER does not intend
to disclose your personal information to any overseas recipients. For more information about how the NCVER will handle your personal information
please refer to the NCVER’s Privacy Policy at www.ncver.edu.au/privacy.
If you would like to seek access to or correct your information, in the first instance, please contact Coal Train using the contact details listed below.
DESE is authorised by law, including the Privacy Act and the NVETR Act, to collect, use and disclose your personal information to fulfil specified
functions and activities. For more information about how the DESE will handle your personal information, please refer to the DESE VET Privacy
Notice at https://www.dese.gov.au/national-vet-data/vet-privacy-notice.

SURVEYS
You may receive a student survey which may be run by a government department or an NCVER employee, agent, third-party contractor or another
authorised agency. Please note you may opt out of the survey at the time of being contacted.

CONTACT INFORMATION
At any time, you may contact Coal Train to:
• request access to your personal information
• correct your personal information
• make a complaint about how your personal information has been handled
• ask a question about this Privacy Notice
Coal Train Australia Pty Ltd
Phone: 07 4939 1445
Email: admin@coaltrain.com.au
Coal Train Privacy Policy - https://coaltrain.com.au/company-policies/#privacy

STUDENT DECLARATION
Coal Train is committed to protecting and managing the personal information you choose to share with our organisation. Through providing this
information, we seek to ensure that you will be able to deal with our organisation in full confidence that your personal information will only be
used by us in the ways we have described to you, that it will be held securely, and when there is no longer any legitimate purpose in retaining such
information it will be disposed of appropriately.
I consent to Coal Train using the information I provide for the purpose it was collected, to assist in the administration of products and services
and to carry out all necessary activities associated with their operational business activities, workplace compliance and legal governance issues. I
understand that my student details may be viewed as part of an audit process by government officials. I have read the policies and procedures within
the Student Handout and relevant course induction and information sheets.
I authorise the use or reproduction of media footage and or photographs for any reasonable purpose within the discretion of COAL TRAIN AUSTRALIA
PTY LTD. I understand that at any time I am able to ‘opt out’ or refuse the use of reproduction of media footage and or photographs by emailing Coal
Train at admin@ coaltrain.com.au or by contacting the office on 07 4939 1445.
I authorise Coal Train to forward my certificate on to my employer. I understand I can ‘opt out’ or refuse this by emailing Coal Train at admin@
coaltrain.com.au or by contacting the office on 07 4939 1445.
STUDENT DECLARATION AND CONSENT
I declare that the information I have provided to the best of my knowledge is true and correct.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

STUDENT SIGNATURE [or electronic acknowledgement]:...................................................................................................................DATE ..........................................

PARENT/GUARDIAN SIGNATURE [or electronic acknowledgement]*:...........................................................................................DATE ..........................................

*Parental/guardian consent is required for all students under the age of 18.

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 ONLY COMPLETE THE FOLLOWING IF YOU DO NOT HAVE A
UNIQUE STUDENT IDENTIFIER (USI) FORM
PLEASE ENSURE THAT THE BELOW FORM IS FILLED OUT CLEAR AND LEGIBLE, ANY FORMS THAT ARE ILLEGIBLE WILL
REQUIRE THE ATTACHMENT OF THE PREFERRED FORM OF ID.
PLEASE PROVIDE THE DETAILS FOR ONE OF THE BELOW:

DRIVERS LICENCE
State: Licence Number: Drivers Licence Card Number:

MEDICARE
Name (as stated on your Medicare card):

Medicare Card Number: Individual Reference Number:

Card Colour Yellow Green Blue Expiry Date:

PASSPORT
Document/Passport Number:

AUSTRALIAN BIRTH CERTIFICATE - EXTRACTS NOT ACCEPTED

Registration Number: Registration Date:

PLEASE READ AND SIGN THE FOLLOWING PRIVACY NOTICE AND STUDENT DECLARATION AND RETURN
BOTH DOCUMENTS TO COAL TRAIN RECEPTION OR EMAIL THE COMPLETED FORM AND ANY ACCOMPANYING
DOCUMENTATION THROUGH TO admin@coaltrain.com.au BEFORE COURSE COMMENCEMENT.

PRIVACY NOTICE
Consent for collection, use or disclosure of personal information

The following is provided to you on behalf of the Student Identifiers Registrar (Registrar).

You are advised and agree that you understand and consent that the personal information you provide in connection with your application for a
Unique Student Identifier (USI):
• is collected by the Registrar as authorised by the Student Identifiers Act 2014.
• is collected by the Registrar for the purposes of:
- applying for, verifying and giving a USI;
- resolving problems with a USI; and
- creating authenticated vocational education and training (VET) transcripts;

• may be disclosed to:

- Commonwealth and State/Territory government departments and agencies and statutory bodies performing functions relating to VET for:
- the purposes of administering and auditing VET, VET providers and VET programs;
- education related policy and research purposes; and
- to assist in determining eligibility for training subsidies;
- VET Regulators to enable them to perform their VET regulatory functions;
- VET Admission Bodies for the purposes of administering VET and VET programs;
- current and former Registered Training Organisations to enable them to deliver VET courses to the individual, meet their reporting obligations
under the VET standards and government contracts and assist in determining eligibility for training subsidies;
- schools for the purposes of delivering VET courses to the individual and reporting on these courses;
- the National Centre for Vocational Education Research for the purpose of creating authenticated VET transcripts, resolving problems with USIs and
for the collection, preparation and auditing of national VET statistics;
- researchers for education and training related research purposes;
- any other person or agency that may be authorised or required by law to access the information;
- any entity contractually engaged by the Student Identifiers Registrar to assist in the performance of his or her functions in the administration of the
USI system; and
- will not otherwise be disclosed without your consent unless authorised or required by or under law.

The consequences for not providing the Registrar with some or all of your personal information are that the Registrar will not be able to issue you
with a USI.

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 STUDENT ENROLMENT APPLICATION
PRIVACY POLICIES AND COMPLAINTS
You can find further information on how the Registrar collects, uses and discloses the personal information about you in the Registrar’s Privacy Policy
or by contacting the Registrar on usi@education.gov.au or telephone 1300 857 536, international enquiries +61 2 6240 8740. The Registrar’s Privacy
Policy contains information about how you may access and seek correction of the personal information held about you and how you may make a
complaint about a breach of privacy by the Registrar in connection with the USI and how such complaints will be dealt with.
You may also make a complaint to the Information Commissioner about an interference with privacy pursuant to the Privacy Act 1988, including in
relation to the misuse or interference of or unauthorised collection, use, access, modification or disclosure of USIs.

DECLARATION
I declare that the information given is true, accurate, complete and not misleading in any way and that by signing this enrolment form I have read
and agree to the Privacy Notice. I have read and consent to the collection, use and disclosure of my personal information (which may include
sensitive information pursuant to the above privacy notice. I authorise Coal Train Australia Pty Ltd to apply pursuant to sub-section 9 (2) of the
Student Identifiers Act 2014, for a USI on my behalf.

PRINT FULL NAME:...........................................................................................................................................................................................................................................................

SIGNATURE:.......................................................................................................................................................................................DATE ......................................................................

Office Use Only: USI Created: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ USI Verified: Yes: Staff Initial:

Student Enrolment Application | 2022